Platelet Rich Plasma (PRP) was initially identified in the 1970s and was utilised in 1987 in cardiac surgery. A number of subsequent clinical studies reported improved healing in fields as varied as periodontal surgery, maxillofacial, dental, skin grafting and cosmetic surgery. The utilisation of PRP treatment globally has steadily increased and expanded e.g. for the promotion of healing in bone fractures and grafts. Use in sports medicine raised US media interest as an innovative treatment when two Pittsburgh Steelers, Troy Polamalu and Hines Ward, attributed their Super Bowl success to PRP treatments they had recently received.

The Science behind PRPPlatelet Rich Plasma is an autologous process; the product is derived from a patient’s own blood. Regardless of the device employed to manufacture PRP, the process essentially comprises of blood being spun in an a centrifuge to separate and collect the buffy coat, diluted with a varying volume of plasma. This product can then either be “activated” with thrombin, or another agent, for rapid, short duration expression of growth factors, or used as it comes for longer duration effect. The product can be manufactured as a gel – for topical application – or as a liquid, for injection.

The platelets obtained from this procedure are in concentrations well above a baseline level; in a typical blood sample platelets comprise around 6%; the platelet concentrate used for PRP may be up to 94% platelets. Concentration of platelets in PRP is dependent upon the device used to manufacture it. Many systems concentrate the platelet fraction by a factor of around 4-6, whilst e+PRP concentrates by a factor of 17-20 times baseline.

The concentration of platelet cells produced is critical for the promotion of healing; they contain numerous essential factors that are necessary for the healing process, such as cell multiplication, recruitment and specialisation, including proteins, cytokines and other essential bioactive factors. Platelets in PRP release growth factors including fibroblast growth factor, platelet-derived growth factor, vascular endothelial growth factor and insulin-like growth factor-1. Distant repair cells, including adult stem cells are signalled by the activated platelets to accumulate at the site of injury, enhancing healing. As the product is autologous in nature, potential complications or side effects are minimised.

Effective Uses of PRP TherapyApplications of Platelet Rich Plasma in head and neck surgery, otolaryngology, cardiovascular surgery, burn and wound healing, oral and maxillofacial surgery, cosmetic surgery and periodontics. There is also widespread, and growing, use of PRP in the cosmetic field, both for skin rejuvenation and as an adjunct to procedures such as laser re-surfacing.

PRP employed in surgical settings has shown a decrease in the frequency of intraoperative and postoperative bleeding, an acceleration in the healing of soft tissues and support of the initial stability of grafted tissues at recipient sites, and reduction of post-operative pain and infection. The delivery of growth factors promotes angiogenesis in healing tissue.

This is a technology that has seen widespread adoption in the USA and mainland Europe, but slower growth in the UK. The ever-increasing volume of literature describing the benefits to patients of employing this product indicate that serious thought should now be given to developing this service in the UK.